Scientific Research

Multiple research studies have verified that patients in the healthcare sector exhibit higher adherence to their exercise regimen when utilizing home exercise programs, particularly those designed by Rehab Lab®, a leading provider of rehabilitation solutions.

Research on the topic of e-Health

In short:

  • The literature on the effects of avatars in health care applications is still limited but results are promising.
  • In the literature that found positive effects of avatar use on compliance, physical similarity, body size, self-image, customizability, body change and avatar behavior were found to be relevant variables.


Avatars, defined as graphical representations of users in mediated environments, can be applied to a broad range of media technologies. Previous research has shown that avatar has great potential to generate positive psychological and behavioral outcomes in health domains, and thus facilitate success in health interventions1. There are several theories that can explain the effects of avatar use; social cognitive theory2,3,4, self-discrepancy theory5,6 and the general learning model7,8. In the social cognitive theory the avatar serves as a role model. Learning will be primarily based on imitation. That may be by adopting qualities that are attributed to the avatar, or by behaving in accordance with the self-image that is activated by the avatar9,10,11,12. In the self-discrepancy theory, the avatar is thought to trigger thoughts about the actual, ideal and ‘ought’ self, facilitating behavioral steps that help to move towards self-improvement13 . The general learning model states that learning is strongly dependent on the environment and views the avatar as a modifiable part of that environment. This brief review on the influence of avatars on compliance does not favor any theory and is meant as a broad representation of what is currently known about the effect of avatars on compliance.



Compliance to healthier behavior seems to be higher when the avatar shows physical resemblance to the user3,8. Physical resemblance is thought to generate a sense of connection. This connection can be in the form of identification, embodiment or ‘self-presence’14,15,16,17. These different types of connection, influence the user experience and, as a consequence, the chosen behavior.


Body size

The physical appearance of the avatar also seems to play a role in compliance. Avatars that have unattainable physical appearances and look like action heroes, do not optimally stimulate compliance. The same results have been found for obese avatars. Studies that compared the effect of different sized avatars, found that avatars with normal physiques were more likely to trigger behavioral changes18,9,19. These findings seem in accordance with the similarity principle; too big a difference compromises the ability to identify.




Dependent on the user’s self-image, the physical appearance of the avatar may trigger different levels of compliance. If a user has sufficient health cognition, a avatar that looks like the actual self can increase compliance6. If a user has a lower level of health cognition, then an avatar that represents the ideal or ‘ought’ self may be more successful20,21,6,22. In choosing an avatar, it seems helpful to have an understanding of a user’s health cognitions. It’s also relevant to track these cognitions in time, to be able to change the avatar accordingly.



Although customizability seems a logical factor in optimizing compliance, it’s hard to make practical assumptions on how and when to customize. Its relationship with compliance still needs to be unraveled in more detail. What has been found is that being able to customize the avatar increases the intention of healthier behavior5. This intention however did not lead to detectable behavioral changes. Another interesting and more applicable finding, is that if being healthy is a part of the ideal self, then having an avatar of the opposite sex seems to strengthen the intention to comply to healthy behavior23.


Body change

Avatars that physically change with the user, are found to have a sex dependent effect on compliance. In men it seems to decrease compliance over time and in women compliance increases4,24. This phenomenon may be explained by the fact that women are more sensitive to their surroundings than men and thus more motivated to keep up. Men are thought to be more indifferent to this type of stimulus, although that does not fully explain why their motivation seems to deflate. Perhaps it’s the sense of false competition that demotivates them.      


Avatar behavior

Several studies have focused on the influence of avatar behavior and compliance. Although most of them have found interaction effects between the behavior of the avatar and the user, the exact relationship seems complex and intertwined with other variables such as similarity and body size15,19.


Practical implications

Given the early stages of research in the field of avatars, practical implications must be contoured with caution. Still the research findings so far, in congruence with theories from the field of psychology and sociology, support a few defendable guiding principles for the use of avatars pertaining to user compliance.

  • The avatar should be similar to the user, not unfit, customizable and demonstrating health consequences.
  • Dependent on the user’s health cognitions, the avatar should reflect the actual, or the ideal or ‘ought’ self.



  1. Fox JA. Avatars for health behavior change. In: Noar SM, Harrington NG, eds. eHealth Applications: Promising Strategies for Behavior Change. New York, NY: Routledge; 2011: pp. 96–109.
  2. Ruiz JG, Andrade AD, Anam R, et al. Using anthropomorphic avatars resembling sedentary older individuals as models to enhance self-efficacy and adherence to physical activity: Psychophysiological correlates. Stud Health Technol Inform 2012; 173:405–411. 16.
  3. Bandura A. Social cognitive theory. In: Vasta R, ed. Annals of Child Development: Six Theories of Child Development. Greenwich, CT: JAI Press; 1989: pp. 1–60. 17.
  4. Fox J, Bailenson JN. Virtual self-modeling: The effects of vicarious reinforcement and identification on exercise behaviors. Media Psychol 2009; 12:1–25
  5. Kim Y, Sundar SS. Visualizing ideal self vs. actual self through avatars: Impact on preventive health outcomes. Comput Hum Behav 2012; 28:1356–1364. 27.
  6. Jin SA. Self-discrepancy and regulatory fit in avatar-based exergames. Psychol Rep 2012; 111:697–710. 28.
  7. Buckley KE, Anderson CA. A theoretical model of the effects and consequences of playing video games. In: Vorderer P, Bryant J, eds. Playing Video Games: Motives, responses, and Consequences. Mahwah, NJ: Lawrence Erlbaum Associates; 2006: pp. 363–378. 30.
  8. Kastenmuller A, Greitemeyer T, Fairclough S, et al. Playing exergames and sporting activity: The impact of identification with one’s game character. Soc Psychol 2013; 44: 264–270.
  9. Pena J, Kim E. Increasing exergame physical activity through self and opponent avatar appearance. Comput Hum Behav 2014; 41:262–267. 22.
  10. Bem DJ. Self-perception theory. Adv Exp Soc Psychol 1972; 6:1–62. 24.
  11. Yee N, Bailenson JN, Ducheneaut N. The Proteus effect implications of transformed digital self-representation on online. Commun Res 2009; 36:285–312. 25.
  12. Bargh JA, Chartrand TL. The unbearable automaticity of being. Am Psychol 1999; 54:462–479.
  13. Higgins ET. Self-discrepancy theory. Psychol Rev 1987; 94:120–121.
  14. Looy J, Courtois C, De Vocht M, et al. Player identification in online games: Validation of a scale for measuring identification in MMOGs. Media Psychol 2012; 15: 197–221
  15. Fox JA, Bailenson JN, Tricase L. The embodiment of sexualized virtual selves: The Proteus effect and experiences of self-objectification via avatars. Comput Hum Behav 2013; 29:930–938
  16. Biocca F. The cyborg’s dilemma: Progressive embodiment in virtual environments. J Comput Mediat Commun 1997; 3:JCMC324.
  17. Ratan R. Self-presence, explicated: Body, emotion, and identity extension into the virtual self. In: Lupicini R, ed. Handbook of Research on Technoself: Identity in a Technological Society. Hershey, PA: IGI Global; 2012: pp. 322–33
  18. Pena J, Khan S, Alexopoulos C. I am what I see: How avatar and opponent agent body size affects physical activity among men playing exergames: Physical activity in exergames. J Comput Mediat Commun 2016; 21:195–209.
  19. Joo YK, Kim K. When you exercise your avatar in a virtual game: The role of avatars’ body shape and behavior in users’ health behavior. Interact Comput 2017; 29:455–466
  20. Sah YJ, Ratan R, Sandy Tsai HY, et al. Are you what your avatar eats? health-behavior effects of avatar-manifested self-concept. Media Psychol 2016; 1
  21. Kim Y, Sundar SS. Visualizing ideal self vs. actual self through avatars: Impact on preventive health outcomes. Comput Hum Behav 2012; 28:1356–1364.
  22. Kuo HC, Lee CC, Chiou WB. The power of the virtual ideal self in weight control: Weight-reduced avatars can enhance the tendency to delay gratification and regulate dietary practices. Cyberpsychol Behav Soc Netw 2016; 19: 80–85.
  23. Waddell TF, Sundar SS, Auriemma J. Can customizing an avatar motivate exercise intentions and health behaviors among those with low health ideals? Cyberpsychol Behav Soc Netw 2015; 18:687–690.
  24. Fox J, Bailenson J, Binney J. Virtual experiences, physical behaviors: The effect of presence on imitation of an eating avatar. Presence: Teleoperators and Virtual Environments 2009; 18:294–303.


There hasn’t been extensive research on the influence of avatars on therapy adherence yet, but some insights are available. If the avatar resembles an action hero or takes a form that seems unattainable to the user, interest tends to wane. In other words, we are most motivated to engage when our avatar bears some resemblance to us, allowing for a sense of recognition. For some, having an avatar that mirrors their current appearance is helpful, while others prefer an avatar representing their achievable future ‘self.’ To achieve this, the ability to choose and customize the avatar is crucial. Even as our own fitness improves over time, having the avatar reflect similar progress appears to be more impactful for women than men.

From a commercial perspective, scientific research indicates that an avatar can aid in maintaining healthy behaviors, emphasizing the importance of avatar resemblance to the user. Many applications fall short in this aspect, but at Rehablab, we have chosen real-life avatars, ensuring everyone can find one that resonates with them. This identification fosters prolonged adherence to healthy behaviors. Initiating healthy habits might not be the most challenging part, but sustaining them is. Rehablab is here to assist in that journey.

The book titled ‘Handbook of Healthcare Research,’ edited by T. Plochg, R.E. Juttmann, N.S. Klazinga, and J.P. Mackenbach, with 380 pages, figures, and tables, was published by Bohn Stafleu van Loghum, Houten in 2007.

The philosopher Hannah Arendt drew attention to dualities such as power and violence, goals and means, politics and science. Murphy’s law forces us to confront the age-old duality of goals and means. The goal is good healthcare. Achieving well-functioning medical care requires evidence-based medicine and evidence-based policies, but these are always the means to the evident goal.

Open the full study (link provided).

Non-specific low back pain (LBP) is a major contributor to global disability. Multidisciplinary pain treatment (MPT) programs, which include educational, physical, and psychological interventions, have demonstrated positive effects on the treatment of LBP. However, such programs can be expensive, and treatment options are often limited to specialized medical centers. Digital interventions such as mHealth may offer a promising approach to support successful self-management of LBP by patients.

Telerehabilitation systems that enable physical therapy sessions from any location have the potential to reduce healthcare costs and enhance the quality of life for individuals in need of rehabilitation. The primary objective of this paper is to present a comprehensive overview of the innovative Kinect-based Telerehabilitation System (KiReS), which offers additional features beyond those currently available in traditional systems. By introducing two new functionalities, KiReS represents a significant advancement towards a new generation of telerehabilitation systems.

Mobile health applications (apps), in recent times, have garnered significant attention from both the manufacturing and research communities. The rapid evolution of smartphones, aided by advanced communication technology, presents challenges in terms of app reliability and accuracy. Understanding these challenges could assist industries and designers in developing better tools to support patients or users in achieving effective apps. The objective of this study is to identify the critical features, contents, and essential user groups for a robust mobile physiotherapy framework.

Health telematics is an increasingly important issue that is significantly improving the lives of patients, particularly the elderly, disabled, and chronically ill. Recent advancements in information and communication technologies, coupled with mobile internet connectivity that enables anywhere and anytime access, are playing a pivotal role in modern healthcare solutions. In this context, mobile health (m-Health) is delivering healthcare services that overcome geographical, temporal, and organizational barriers. M-Health solutions are addressing emerging issues in healthcare services, including the rising prevalence of lifestyle-related chronic diseases, the high costs of existing national health services, the need to empower patients and families to manage their healthcare, and the necessity to provide direct access to health services, regardless of time and location.

Despite a considerable amount of research on the factors influencing the adoption of mobile or wearable health care technology (mHealth) and its acceptance among patients and other health care professionals, there has been limited investigation into the viewpoints of physiotherapists regarding the use of mHealth in their present or future practice. This study aimed to examine physiotherapists’ attitudes towards mHealth by utilizing a modified technology acceptance model questionnaire.

No matter how necessary the measures regarding COVID-19 are, many professions are severely impacted by them. Take for instance physiotherapists, whose work mainly involves physical contact. With the often-empty schedules that result from this, they are forced to be creative; healthcare providers have never had to change so rapidly to get their expertise to the patient. Therefore, the current crisis, unpleasant as it may be, offers an opportunity to evaluate our healthcare and permanently integrate technology into our healthcare offerings.

Greetings to the Dutch version of Deloitte’s 2019 Global Mobile Consumer Survey, an annual investigation into global trends in mobile consumers. This “Dutch Cut” provides information on device ownership, connectivity, operator stores, mobile payments, smartphone usage, mobile gaming, and privacy.

In this piece, I offer a discussion on the topic of the Special Issue, which originated from a panel organized by the editors during the 2011 International Pragmatics Association conference in Manchester, England, where I was invited to serve as a discussant. Instead of reviewing the content of each article, my goal is to provide some context to emphasize the arguments and discoveries of the contributions as a whole. Hence, I will comment on the theme linking the examination of language usage and the involvement of members in technologically mediated communication environments.

The purpose of this article is to examine essential communication concerns regarding the development of efficient and compassionate eHealth applications, aiming to offer guidance for strategic planning and deployment of health information technologies.

Research on general healthcare

The updated guideline for Osteoarthritis hip-knee by Rehab Lab is designed for general physiotherapists and remedial therapists who treat individuals suffering from osteoarthritis in the hip and/or knee, including the pre- and post-operative periods related to joint replacement surgery.


The “Professional Code for Physiotherapists” has been revised from the 2012 edition of the “Professional Ethics and Rules of Conduct for Physiotherapists” and emphasizes the growing significance of the patient’s role.


The “Stroke Guideline” from the Royal Dutch Society for Physiotherapy is designed to assist first, second-, and third-line physiotherapists in treating patients with cerebrovascular accidents (CVAs) as the primary diagnosis, across the entire healthcare continuum.


The Ankle Sprain guideline by the Royal Dutch Society for Physiotherapy (KNGF) focuses on the diagnosis and treatment of ankle injuries resulting from inversion trauma to the lateral capsular ligament apparatus and functional instability of the ankle. The guideline also covers measures to prevent recurring injuries, as well as sport-specific treatment and rehabilitation recommendations for acute ankle injuries and functional instability.


This guideline outlines the necessary information that must be documented in a physiotherapeutic file. It specifies the data required for compliance with the Medical Treatment Contracts Act (WGBO) and for physiotherapeutic clinical reasoning. The guideline provides a concise overview of this data with a brief explanation, while the accountability and explanatory notes offer more detailed information. This directive has been effective since January 1, 2020. For dossiers created between 2016-2019, the 2016 reporting guideline applies, while the 2011 reporting guideline is applicable for the period 2011-2015. Both can be accessed under the downloads section.


The Cardiac Rehabilitation Guideline of the Royal Dutch Society for Physiotherapy provides guidelines for physiotherapeutic treatment of patients eligible for cardiac rehabilitation, both in the clinical and outpatient phases.


The recently released paramedic guideline by HASP offers a framework for the exchange of patient referral information between physicians and paramedics. This collaborative effort involved other professional associations in the paramedical field, and supersedes the 2012 HAFT guideline (Information exchange between general practitioners and physiotherapists).


The new HASP paramedic guideline provides physicians and paramedics with the basis for transferring patient referral information. The guideline was created through a collaboration between other paramedical professional associations, and thus replaces the HAFT guideline (Information exchange between general practitioners and physiotherapists) published in 2012.


The guideline outlines the physiotherapeutic approach to treating patients experiencing pain and/or other symptoms in the arm, neck, and/or shoulder due to a health condition.


The Low Back Pain and Lumbosacral Radicular Syndrome guideline of the Royal Dutch Society for Physiotherapy is a guideline for physiotherapists in the treatment of patients with low back pain and/or symptoms consistent with lumbosacral radicular syndrome.


The guideline on Meniscectomy by the Royal Dutch Society for Physiotherapy outlines the physiotherapeutic diagnostic and therapeutic process for patients who have undergone a primary meniscectomy (arthroscopic or arthrotomy).

The guideline on Oncology by provides a set of recommendations for physiotherapists and remedial therapists who are involved in treating patients with cancer or those who have undergone cancer treatment.

The Parkinson’s Disease guideline of the Royal Dutch Society for Physiotherapy (KNGF) is a directive for the physiotherapeutic management of patients with Parkinson’s disease, based on the European Physiotherapy Guideline for Parkinson’s Disease.

The Rheumatoid Arthritis guideline of the Royal Dutch Association for Physiotherapy is a guideline for the general physiotherapist in the treatment of people with this condition.

On stress (urinary) incontinence provides guidance on the physiotherapeutic treatment of stress (urinary) incontinence (SUI) or mixed incontinence with SUI as the dominant form in both women and men.

Guideline on Symptomatic Peripheral Arterial Disease provides guidance on the physiotherapeutic diagnosis and treatment for patients with this condition.

Self-management in healthcare refers to the ability of patients to actively participate in the management of their own health, through behaviors such as monitoring symptoms, adhering to treatment plans, and making lifestyle changes. This approach is increasingly recognized as an important aspect of healthcare, as it empowers patients to take a more active role in their own care and can lead to better health outcomes.

Guideline for Pregnancy-related pelvic and/or low back pain (ZGBP) outlines the diagnostic and therapeutic process for women who experience pain in the pelvis and/or low back during pregnancy or up to 9 months after childbirth. The guideline is applicable when there is a clear correlation between the pregnancy and the onset of pain in the pelvis and/or low back, resulting in limitations and participation problems, and the patient actively seeks treatment.

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